Focus Pocus

It's Day 2 of Operation: Start Studying for the Boards, and it is not going well. I keep sitting down to read on gynecology, a subject I actually enjoy, and I just cannot focus. I found a TINY spot in my apt with just a little bit of WiFi reception, so I am finally catching up on all the entertainment gossip I have missed, and tracking England vs Germany. (For my British cousins, I'm sorry to say that I am rooting for Germany. Rooney just doesn't do it for me, and England is playing like a bunch of babies.) I watched Gandhi yesterday, and finished part 1 of the Glee season on DVD, and futzed around, and cleaned up my living room, and basically found every possible way of avoiding my homework.

I am SO not ready for residency. Or responsibility. Or anything.

(On a related note, I just heard a raucous cheering coming from my computer. Turns out that the NYTimes has their World Cup blog programmed to cheer everytime a goal is scored. 4-1 Germany, bitches!!)

If things go well, I might be showing her my O-face.

Sorry that I've been gone so long! There has been a plethora of craziness, which started with a whole host of personal junk and moving to Queens, and ended with an intimidating orientation week.

First things first - I didn't realize there would be so many interns starting with me! Most are not in my field, but I recognized a lot of classmates and overall people seem decently nice. We will all be rotating together during our first year, which makes me feel good because I won't be going through it all alone. My program took 5 interns including me, and the program also does have a lot of girls, which is another good thing. (Although women can be bitchy. I'll have to look out for that.) Most of the faculty seemed approachable and full of useful advice, like DON'T PISS OFF THE NURSES BECAUSE THEY RUN THE HOSPITAL and DON'T PISS OFF THE RADIOLOGISTS BECAUSE WE DON'T HAVE A PACS SYSTEM HERE. Overall, though, the message is that this will be an interesting year that I will look back on for the rest of my life and blah, blah, blah. Dear God, I just want to make it to vacation in October. Love, Sarada.

One thing that kind of struck me was how Fight Club the whole thing was. Residency is, by and large, like being in the army. Which makes me feel great because there's no earthly way I'd survive in the army. There's a clearly delineated hierarchy, and when you have an issue, you'd think that you just go straight up the hierarchy. Not so, apparently. This is FIGHT CLUB, and the first rule of fight club is that you DO NOT TALK ABOUT FIGHT CLUB. So if I have an issue, it's basically down to my chief resident to care or not care about helping buffer it with the offending party. They were pretty clear about not taking things to the program director or chief of surgery, which I was surprised about. Supposedly this is for our protection, but somehow not being able to talk to someone who is actually employed by the hospital is somewhat disconcerting. I completely understand the need of making sure your chief resident is on board, because they're in charge of the team and it isn't fair to blindside them with some issue and let it escalate unnecessarily. But the whole thing is kind of sweep-it-under-the-rug.

The good news is that my co-residents and chiefs seem like decent people. They were really insistent that we go to them for any help we need when it comes to managing patients or doing minor procedures, as well as reporting any mistakes made. It's an important message to give, because nobody wants to look incompetent or unprepared, and people will lie/pretend/ignore issues to maintain a game face. I keep thinking about how I'd feel if I was that patient and someone was putting their own ego above my health management, and I'm glad that the department is working hard to make sure we don't go hiding or beat ourselves up for mistakes at the expense of fixing them. We have mandatory socializing today at a bar, which I suppose is to encourage everyone to let their hair down / find out what we're really made of when we're drunk. I'm trying desperately to get some studying done before I go, because we have to read a ton of Sabiston's Textbook of Surgery each week, along with studying for the Step III of the board exams. I'm starting off with my Case Files: Ob-Gyn review book, because my first rotation of the year is Ob-Gyn (gulp!) and I really don't want to look unprepared in front of the attending. Although, let's face it, I am utterly unprepared. I don't even have my white coat or beeper yet.

In other news, my apartment is officially set up, but I foolishly only installed one AC unit and now it is balls to the wall hot in here. Hopefully in a day or two I will have my second unit in place and I won't be drinking gallons of water a day. I also still do not have internet, which is a bigger problem than I thought because I have a lot of registering for exams and such to take care of. (Also, I can't blog.) Ah well. At least my kidneys and sweat glands are happy.

An Odd Coincidence

Well, it's T-minus 6 days until orientation, and I'm getting a bit nervous. I think my parents picked up on that, because they suggested we hit the temple and do a little pre-residency prayer. I'm not a hugely sentimental person, but it seemed appropriate given just how COMPLETELY SCREWED N THE BUTT I WILL BE, so I was all for it.

We went to the temple this morning, and as we were lining up to take prasadam (blessed food) from the priest, we managed to notice an older couple there who we recognized. The man was a semi-retired pediatrician, Dr. S, who passed his practice onto his son. And at the risk of sounding melodramatic, this guy saved my life when I was 12.

My own pediatrician had a solo practice at the time, and on the days when he had to be away for whatever reason, he had us call Dr. S. Dr. S was a well-respected pediatrician in the area, solo praticing for many years. He was knowledgable, kind and always relaxed. I always remembered for him for his glass eye, which at that time was just about the coolest thing ever - I kept waiting for him to pull out a peg leg and dirty-mouthed parrot and say things like "ARRRRRR!". My mom took me to see him because I seemed to have a sore throat that wouldn't go away. I don't remember that much of it well because it seemed like a totally normal exam to me at the time, but he heard a pretty decent murmur during auscultation and leaped into action ordering EKGs and echos and making sure I got evaluated immediately by a pediatric cardiologist.

Without giving away all the nitty gritty details, I wound up in the hospital for a week with congestive heart failure, and on bed rest for 2 months afterwards. It was a great catch on the behalf of Dr. S, and I received incredible care from the pediatric cardio team. As a result, I survived a quite serious situation with virtually no residual health problems barring a new allergy to aspirin.

At that time, I never fully understood how big a deal this whole thing was. I never felt sick, never felt scared, and never looked back. (But being trapped on bed rest during the OJ Simpson trial was enough to make anyone vomit.) But I came across my old records a few days ago while hunting for my vaccination sheet, and was surprised to find how intensive the treatment was. I was also surprised to find how thorough the care was, and in light of how much spotty medical treatment I have witnessed in the past two years, I was impressed by how much Dr. S showed his care. I was lucky to have had him.

My family has pretty much put this all behind us, as we have newer and bigger things to worry about and look forward to. This, for my parents, has represented the culmination of all their efforts and hard work (and mine), and how much we've all been able to do. But seeing Dr. S as we prayed for the start of my surgical residency was, to say the least, auspicious. It reminded us all of how utterly lucky we have all been in life, to be healthy and safe and together.

Stars in my eyes

My big fear is that the post you're about to read is going to sound like I'm shilling for a product, and I don't want you to think I've been paid or anything. This is all on my own dime.

I'm in love with my phone.

I finally got the HTC Incredible. And damn, it is. It is slim, light, with a lovely smooth touch screen and easy to use navigation buttons as well. It has an 8 megapixel camera with flash, which I never thought I'd care about, now seems to fit in the unexpected category of Things Sarada Though She'd Hate But Love Instead (along with Chevy Silverado pickups and country music). It has a decent amount of memory, which is convenient because those apps are pretty addictive. Even with my genetic tendency to be cheap (I'm refusing to buy any apps till I get my first paycheck), the apps are pretty damn good.

I can read all the news I want and then some. I can sync seamlessly with both my gmail accounts, even chats, and my google calendar as well. I can monitor my account with my cell phone carrier. I have Epocrates for free. (And once I stop being cheap, I'll get a nifty EKG analysis app.) And, best of all, I can use Skype to call my sister in Thailand whenever I want, without using up my minutes!! It's pretty damn sweet, let me tell you.

However, in the interest of BALANCED REPORTING, let me give you 2 downsides:

1) Battery life blows. But I got a free Task Killer app, which quietly closes all your open apps for you so that your battery doesn't die quite so quickly. I will most likely have to buy the new extended life battery when it comes out, and perhaps an extra charger or two for work.

2) I don't have a second HTC Incredible to take a picture of me happily using my first one. Curses. And so I include this portrait of interpretive dance:



(Ok, I know the last one doesn't count. But it really is bugging me all the same.)

The Wake-Up Squad

Hooray for re-certification!! I am officially qualified as a life saver. (Although I haven't quite figured out how to find the belly button in order to do the Heimlich without tickling the victim.) We finished an hour early, so I happily got in the car and drove off into the sunset. I was just aimlessly listening to commercials on the radio when a phrase caught my attention: "Shift Work Sleep Disorder". The phrase was then followed by an ad in which "The Wake-Up Squad" urges you to be evaluated for said disorder, and then be treated using the medication Nuvigil (Armodafinil) by Cephalon.

My first reaction was, this is a disorder?? It's obvious that doing shift work or 24 hour call can mess up your circadian rhythm and make you tired, etc. But when I looked up the signs and symptoms at the Cleveland Clinic just includes difficulty concentrating, headaches and lack of energy. Well DUH. The consequences of this supposed disorder included increased accidents, increased work-related errors, increased sick leave and increased irritability, mood problems, etc.

I don't get it - aren't these just the same things we all experience if we are truly sleep-deprived and forced to function anyways? Isn't sleep deprivation a good enough term to cover this issue? I did look up the word "disorder" and it is vague enough, I suppose: disorder /dis·or·der/ (dis-or´der) a derangement or abnormality of function; a morbid physical or mental state. I guess sleep deprivation qualifies as a disorder, but I just don't think it's exclusive to shift work. Having a baby makes you sleep deprived. So does staying up for 4 days straight to play video games.

And the other thing is, what's the deal with this brand new medication for it? It might just be me, but when I really can't sleep, a good old fashioned Benadryl does the trick. (When I really REALLY can't sleep, I give up and start re-reading Harry Potter. JK Rowling, I love you.) The drug apparently was going for FDA approval for jet lag (which, again, to me fits the same criteria of sleep deprivation), and got turned down in March of this year.

So, my question is, who decides when something is a disorder? How do they decide when something is distinctive enough to warrant a separate classification? And will someone please tell me if I'm allowed to get time off for my impending, inevitable Shift Work Disorder starting in July? Because I'm pretty sure it's going to be a doozy.

B.L.S**t

Around this time of year, you'll find a lot of interns doing the same thing across the country - starting orientation for their new positions, and re-certifying for Basic Life Support and Advanced Cardiac Life Support training. Our school had us train for both before starting our 3rd year clinical rotations, so this basically serves as a bit of a refresher. Most of the time, it's a waste of time. And mine was too, except that it wasn't in certain ways.

It certainly didn't help that I spent a day flying around the city looking for bookstores which stocked a BLS book, only to find that the course I was scheduled to take was ACLS. So I took frantic notes while at the course, since I am terrible at remembering which drug goes when. Idiotically, I had to be told that you DE-fibrillate someone when they are, in fact, in atrial or ventricular fibrillation. Rocket science, I tell you. We also STILL do not have a schedule, which makes it impossible to plan ahead. Even worse, one of the other guys there told me they will only give it to you 2 months in advance, which makes planning trips or other excursions difficult to do. And PS, as an intern, I am not allowed to pick a vacation time unless I am a) getting married or b) physically pushing out a child. Baahhhhhh.

But I did meet one of the family practice attendings, who was actually very nice and included a lot of great advice for how to interpret things and handle the situations in the real world. I also met a few of my fellow interns, both for surgery and other fields, which was nice. I was definitely put off to find that at least two were smokers, but that's the sort of thing that always shocks naive little-girl me. Sigh. Another benefit from the session: 6 Second ECG Simulator. This little baby lets you test yourself in the safety of your own home, and it's pretty decent at it. Theoretically, I will practice more with it, because the only one I feel comfortable recognizing is asystole (aka, the flatline).

And lastly, my search for the HTC Incredible continues. I checked out a Verizon in the city, only to find that the ENTIRE NEW YORK REGION is utterly sold out, with no idea as to when the newest shipment will arrive. I could order online, but they won't arrive till July, and I wanted some time to make friends with the phone. So I checked in NJ, and Verizon had the same story, but an authorized retailer let me reserve one. Triumphantly, I went to the store this evening, only to find a line a mile long, with no sign of movement. And so, I shall try a third time tomorrow morning.



Incredible, why must you taunt me?

You Kids Today and your Newfangled Contraptions

Being the news junkie that I am, I usually look forward to Tuesdays because that's when the New York Times does its Science and Health sections. Today was kind of a bust, but I did notice one piece about adopting electronic medical records systems. The basic gist of the piece is that the government is trying to push hospitals and doctor's offices to modernize and start using electronic medical records, in hopes of improving record-keeping and also record-sharing between professionals.

Predictably, there has been a lot of resistance to this, for a variety of reasons. Many medical professionals work in areas where there isn't a major hospital to connect with, or in areas where there aren't a ton of specialists. (Meanwhile, you can't swing a dead cat around the New York City area without hitting a specialist.) And frankly, switching over is expensive, which is frustrating when you have worked with EMRs and have realized that it's not very complicated code.

But that being said, a part of me wonders if all this controversy is really about a much more simple truth - old people don't like change. I've seen a lot of older doctors really struggle to figure out basic stuff like how to save their work, or how to look up labs. And I'm not saying it's easy, because EMR systems are user-unfriendly to say the least. But rather than taking a course to familiarize themselves, or just diving in to get used to it, they just write off the whole thing as useless and kvetch (while brandishing their canes?) about the good old days where you didn't have to document everything and the doctor's word was TRUSTED.

Now, it might just be me. But I'm really not the brightest crayon in the box, and I honestly can't remember what I've been told 10 minutes later, especially if I am tired or distracted. In an EMR system, you can continuously save and modify what you've written, and copy and paste data so that there's less human error. And considering how many cooks are messing with an individual patient's soup, I think it's helpful to have one program that everyone is using, which keeps track of who put what in the record. It creates a certain amount of accountability, because everyone's checking everyone else. I never really thought what I wrote as a 3rd year medical student mattered, but I've had nurses and residents come up to me a week later to ask about my plan of action for a given patient. (Usually they were scolding me, but looking back, it was nice knowing that I mattered a tiny bit.) It also makes it easier to figure out what a patient's story is in the broader sense, whether this is a patient who follows up on care and recommendations or not, or whether this is a patient with a history of drug-seeking behavior, or whether this is a patient whose care is so complex that he / she deserves to be specially discussed with your attending.

I can understand that the isolated doctor's office in Wichita, KS won't see the benefit of switching over for a long time, and it's not a terrific economy at the moment so this stuff will sting when you pay for it. And I'm not sure that EVERY hospital should be mandated to adopt the systems either. But I think the way to handle this is a little bit of carrot and stick. If I were the president (sounds like a 3rd grade essay...), I would mandate that all hospital systems with X number of patients or higher must adopt an EMR system that meets ABC criteria. This part could be a tiered system, such that every few years a new mandate kicks in for a slightly smaller hospital system, and smaller after that. This would give smaller systems time to save up for adopting an EMR, and also get to see them in action at larger institutions. In the meantime, entice the doctors local to those systems and give them a small bonus for also adopting. In this way, it would be good business for a doctor to use the same EMR, because it facilitates communication and referrals with the hospital system. Eventually you'd get a trickle-down effect, and increasingly rural areas would adopt the practice in keeping with standard of care.

On the other hand, I'm thinking of replacing my Palm Centro with a new HTC Incredible. And I'm pretty sure that when my battery dies after 30 min of use, I will be throwing it out the window and shaking my cane at it, too. Damn kids and their crazy apps.

Idle Hands

Most specialties like to ask why you're interested in ________ specifically, as in "What is it that draws you to Obstetrics and Gynecology?" and you're supposed to answer from the heart, such as "Well, I enjoy cottage cheese and the smell of rancid fish." My stock answer for surgery was that I liked the thought process, the challenge of growing my bank of knowledge (a carefully chosen phrase) and also the problem-solving that it required.

We're now on Week 5 Of Vacation, though, and I'm realizing that perhaps the real answer is something a lot simpler - I hate idle hands. This isn't to say that I don't absolutely love being a couch potato, zoning out or being otherwise slovenly. But after awhile, I stop being able to sit still, mentally and physically. My boyfriend often comments on how I constantly fidget, or create distractions for myself when the task is mental (like studying). It's really common for me to pull out my phone to check the news, only to not even read it, just click through sites. (Although I am a thorough news fiend. It's just that after 2 pm, there's rarely anything new to report, and I still check anyways.)

The one and only way I can stay focused on a task is when it is a physical, mindless, fine skill thing like typing or sewing, OR it is to take up a new obsession. And this time, it's watching back episodes of Lost. And analyzing. And re-analyzing. This is a pattern I have maintained so many times over the years, and usually it ends up with me suddenly dropping the show. Before Lost, it was Cesar Milan, then Buffy, then Bones, then A&E Intervention. You can see from this pattern that I tend towards shows that either give me the "EEEE!!!" feeling (ex: Spike the vampire) or the "ugggghhhh" feeling (ex: dead bodies for autopsy / crime-solving on Bones). And so, I make a plea to Hulu: please put up the rest of Season 6. I will be eternally grateful. Also, any gratuitous Daniel Dae Kim clips would be much appreciated.



Mmmmmmmmmmmm.

(Note for my own Asian: He makes me miss you!! I promise!! =*)